Probiotics Combined with Antibiotics Can Help

Almost all of us will be faced with the need to take an antibiotic at some time. Certainly they are overused in many instances, but can also be life-saving. Besides killing the bacteria that are causing the infection, antibiotics can also wreak havoc with the gut microbes. If you think of your gut flora like a tropical rainforest with vast diversity, think of antibiotics as a slash and burn therapy that does not discriminate between friendly probiotic strains and pathogenic invaders.

It is helpful to think about probiotics as the guardian angels of the GI tract. They go into the gut neighborhoods, chase away the bad guys and support the environment so your good guys can re-populate. The probiotics do not become a permanent part of your flora, and they will go away within a few weeks after you stop taking them.

To some people, it sounds counterintuitive to take a supplemental probiotic at the same time you are taking probiotic-killing antibiotics. Nevertheless, a lot of medical research is showing great benefit.1 Combination therapy is somewhat controversial; the benefits are mild in some cases, but profound in others. Since any one person’s gut flora is as unique as their fingerprint, it is difficult to determine an optimal strain, dose or duration of probiotic therapy.  But we know this:

  • C. diff is a serious bacterial infection that can overwhelm a person’s immune system and cause severe bloody diarrhea, dehydration, and even death. Patients taking probiotics while on antibiotics saw an incredible 60 percent reduction in the risk of developing C. difficile infection2
  • Pediatric and adult patients taking the probiotic Lactobacillus rhamnosus during antibiotic treatment had a 10 percent less risk of contracting antibiotic-associated diarrhea3
  • Probiotics taken during antibiotics can reduce the duration of diarrhea side effects by an entire day4
  • By reducing side effects that cause patients to stop their antibiotics too soon, probiotics may also help prevent the development of antibiotic resistance.5

Tips for Taking Probiotics with Antibiotics:

If probiotics combined with antibiotics help to prevent side effects, to recolonize the gut flora, and to reduce antibiotic resistance, then is there a recommended way to take them together?   Unfortunately, the evidence for this is not as clear, but the collective wisdom of experienced practitioners using this strategy is very valuable.

  1. Find a Good Quality Multi-Strain Probiotic Formula

Look for a high-quality formula with a variety of human-resident strains (those from the Lactobacillus, Bifidobacterium and Streptococcus families). We also like to use the probiotic yeast called as Sacchyromyces as it is not nearly as affected by the antibiotics.

Choose a formula that guarantees that the live bacteria will survive into the small intestine. Stomach acid can dissolve most gel caps and kill the probiotics before they have a chance to work.

We generally avoid getting probiotics supplied by the internet. WHO KNOWS what temperature and storage conditions they have been exposed to? Some even require refrigeration. These are living organisms that need a bit of TLC. Get your probiotics from a brick and mortar store or practitioner.

  1. Dosing time matters

Allow at least two hours in between dosing the antibiotics and the probiotics.  Dosing too close is a guarantee to kill the probiotics. Give the medicine time to get absorbed and get out of the stomach and small intestine. We recommend starting probiotics within the first dose or two of the antibiotic and taking them for more days that the antibiotic prescription alone.

  1. Keep going

Once your course of antibiotics is done, you have some gut repair to do. One single dose of antibiotics changes your gut flora forever, and it can take an entire year for your gut to recover from a course of oral or IV antibiotics. We recommend at least 4 weeks of probiotics, sometimes a year, and sometimes FOREVER depending on your case. We typically rotate through a few different brands if you are on a longer-term plan, so that the guardian angels stay alert and keep the bad guys out and the good guys growing.

  1. Use probiotic foods too!

We want a diversity of bacteria to support the gut “rainforest” so adding a variety of probiotic foods can be helpful. Almost every nationality uses some form of probiotic food in their traditional diet, so consider using fermented foods or beverages like kimchee, sauerkraut, some pickles, yogurt (natural not the sugary gel kind), miso, kefir, and kombucha.

  1. Add Prebiotics

All cells need food to grow and thrive. This is also true for probiotic bacteria. Fortunately they like some of the same foods that we like. Onions, garlic, apples and bananas encourage the growth of probiotics, so do Jerusalem artichokes (called sun-chokes), asparagus and dandelion greens.  Junk food is a prebiotic killer, so be sure to limit these non-nutritive food-like substances especially when on a gut recovery plan.

(Note: The only harm of taking probiotics seems to be in people with a profoundly weakened immune system and severe intestinal dysfunction. There have been a few instances of blood infections (sepsis) that seem to be related to the probiotic.)


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Ellie Campbell DO